MEDICARE: NOVACARE OUTPATIENT REHABILITATION OF CALIFORNIA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1366446916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVACARE OUTPATIENT REHABILITATION OF CALIFORNIA INC

Provider Business Mailing Address
First Line	:	1090 SUNRISE AVE
Second Line	:	STE 140
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-4466
Country	:	US
Telephone Number	:	916-782-1212
Fax Number	:	916-773-1481

Provider Business Practice Location Address
First Line	:	1211 N DUTTON AVE
Second Line	:	STE G
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-4638
Country	:	US
Telephone Number	:	707-579-1411
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. DAVID SMITH
Credential	:
Telephone Number	:	916-782-1212

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	08/22/2020

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